Do nurses have time for reflective practice?

Reflective practice is defined as the process of making sense of events, situations and actions that occur in the workplace.

Although many nurse education programmes (leading to registration) include modules on reflective practice, organised opportunities to reflect are rare in the busy, pressurised world of frontline practice.

Reflective practice is a key skill for nurses.

Engaging in regular reflection enables practitioners to manage the personal and professional impact of addressing their patients’ fundamental health and wellbeing needs on a daily basis.

During most of our very hectic days we had to work on automatic pilot which is what good training and expert skills is all about and essential in emergencies. However, with more time to reflect and even time which we very often did not have available to us to look up new information as required and also time to reflect on alternative courses of action would greatly enhance care. Often we had to take the quickest and best know option only to reflect later at report or in our own free time off the ward. On late shifts this often caused restless nights when we thought over what else could have been done and whether we could have done things better.

Reflection is an important aspect. I strive to be a better person each day and I practice reflection and it helps me.

I also take the time to encourage others to reflect. For example, I learnt of a situation at work which saddened me; I learnt that a vulnerable resident was woken up at 5:30 every morning and bathed and brought to the lounge to remain there until night staff brought her back to her room. During a night shift was told by my assistant carer "We usually get X up now". I told her not to speak to me of such things as I would not be getting up anyone at 5:30 as I saw it as abuse. I said I did not see it anywhere in her care plan that she was to be awoken at this time. I said if she is wet then out of compassion I would change her and make her comfortable and leave her in bed. The carer an ex nurse was upset at my actions.

When the panorama programme was aired, about the abuse of the 80 year old lady in a nursing home, I went to work one morning and this was the topic. The speakers verbalised being upset by what they had seen. I took the opportunity to encourage them to 'look closer to home'. I agreed that it was awful and said I could see how bothered they were because they could see the physical abuse but that there were different forms of abuse including institutional abuse. I said that to take X out of her bed at 5:30am and bathe her was abuse and that in the light of panorama we need to be reflective. I was taking the opportunity to encourage reflection and to appeal to their better sides. I was reported to the registered manager as saying I was going to call panorama. The manager asked me what did it have to do with me what time X got up and why did I care. I looked at her in askance and asked her if she realised what she had asked me. Apart from a duty of care to X, a vulnerable person I was guided by compassion and knew that this was wrong. I was ostracised by the Registered Manager Nursing Manager and others. She said this has been going on for years before I came there!!

I now reflect "Did I do my best for the vulnerable patient? Whats your view?
I was told that I helped because they have now documented that she is to be woken up at 7 and not 5:30. I still said that was too early as she did not have any appointments and was not going to work.

I think it is up to us as nurses to educate other associated with health care and the elderly to reflect in this manner and not carry out tasks which are abusive or not in the best interests of their patients. there are alternatives to putting organisational needs before the needs of patients.

Have no doubt in your mind at all that you did do your best and well done you. I too have been in similar situations where you meet this institutionalised resistance. Would still do it again though. To thine own self be true & illigitami non carborundum.

A few years ago I was so busy on my ward(s) I didn't even have time to have a cup of coffee. At the end of the day I'd go home and sleep on the couch. I was exhausted, I'd fall asleep at the drop of a hat. Now I do have time for reflection. My job, though often busy, is far more rewarding. I work in the Falklands, at a dynamic little 26 bed hospital. It's so nice to have the time and energy to reflect on my practice. What a fab place!

What noone is saying, is why we have to do so much reflective practice and CPD in our own time and at our own expense? Surely there should be much more time allocated WITHIN our working week if it is mandatory?

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